Live: Extraordinary Liverpool council meeting called over Brushwood failings
Councillors are meeting to discuss what is being done after a recent CQC report revealed ‘widespread’ and systemic problems at the council-owned care home
Liverpool councillors are gathering at the Cunard Building this afternoon for an extraordinary meeting to scrutinise serious failings at Brushwood Care Home in Speke.
The council-owned home was placed into special measures after the Care Quality Commission (CQC) rated it inadequate in a report released on September 9th which detailed widespread failings.
Concerns identified by inspectors included issues around safeguarding, staffing, medicines, residents’ nutrition and hydration as well as the condition of the home and problems with leadership and governance.
Liverpool Council has apologised to residents and their families and said an improvement programme is already underway. The local authority said it had already identified concerns during an internal inspection in March, several months before the CQC carried out its unannounced visits in July.
The council said concerns identified internally has been raised with the CQC by officers prior to the inspection. For the full background to tonight’s meeting, you can read our earlier report here:
Brushwood failings under scrutiny as council apologises after CQC inspection
In January the council was talking about ‘impressive results’ at its Speke care home, but just two months later its own internal inspection found widespread problems
Lisa Rand
The Monitor will be reporting live from the Cunard Building when the meeting starts at 5pm.
The most recent updates will appear at the top of this page, which should refresh automatically.
Thanks for following tonight’s meeting, a special scrutiny meeting called after the ‘inadequate’ rating received by council-owned and run Speke care home Brushwood, following a CQC inspection carried out in the summer.
What did we learn? Well, it’s not just Brushwood that has been inspected by the CQC. Its sister home Millvina House, also owned and run by Liverpool Council, has also recently been inspected - just two weeks ago - so we’ll hear more about that in due course. Officers also spoke of steps being taken to address issues at both homes, including around workforce training, attempts to reduce reliance on agency staff and culture change.
If you scroll down to the bottom, you can follow the meeting from the start.
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6.19pm - Councillors have agreed the summary of the meeting to be brought to cabinet, a task and finish group to be set up and KPIs brought for councillors to consider. Meeting over.
6.18pm - Cllr Nicholas is now closing the meeting. ‘It’s a difficult discussion which we need to have because we all sit around here and want the best for our citizens in the city. It’s not just Brushwood or Millvina but all who require social care and health.’
6.17pm - If staff are interested in becoming permanent, the council do ‘conversions’. ‘We do it all the time with social workers’ Lubanski adds.
6.15pm - ‘I know how difficult this job is’ Cllr Prince said. He is asking about the bank staff and what training has been made available to them ‘that seems to be one of the weaknesses’. He also asks, ‘what can we do to increase the permanence of the staff’ to avoid bank staff. Jordan Smith clarified if this meant agency staff, and said those staff have a training record that comes across with their documentation. There is an induction on first arrival in the home. ‘As we’ve been going on this journey, we’ve been tweaking the induction’ Smith adds.
6.14pm - Cllr Nicholas is asking if the training is up to date and Jordan Smith said the training is ‘shared’ as part of a ‘one team approach’.
6.12pm - ‘When those staff come to the care home are they already trained?’. Jordan Smith said they are ‘substantive nurses that already work in the home’ although there can be agency staff. Some have been ‘tuped’ (this is being transferred from one employee to another on same conditions) between different providers. Jason Oxley clarified all of the residential support workers, care staff and senior care staff, managers and ancilliary staff are provided by the council. There are 48 care assistants and 12 senior care, deputy manager, registered manager plus anciliary staff within the home, he added.
6.11pm - We’re hearing there are 16 nurses across both homes and there should be two on each shift, ‘but at the moment we’ve got additional nurse capacity’ and a quality matron, meaning four PC24 staff on each shift. Lubanksi said PC24’s staff is ‘a third of the staffing complement.’
6.10pm - Lubanksi is responding: ‘I am confident in terms of what we’re doing now and what we’ve got in place’, referring to the role of Jordan Smith as head of service.
6.09pm - Cllr Hasan asked Cllr Coleman - ‘if the last three years it didn’t improve, why should we trust’ it would improve now? ‘Keep us confident that we can trust this time there will be improvements’.
6.08pm - ‘I can’t state what the outcome for Millvina will be…it’s important that it is transparent.’ She said families most wanted ‘clear timescales around when things will be done’
6.07pm - Cllr Kris Brown asked whether the task and finish group would ‘slow down’ activities and Lubanski said she would welcome a task and finish group.
6.05pm - Jordan Smith is talking about the community matrons chairing weekly multi disciplinary team meetings. Jason Oxley said the quality matrons have been ‘instrumental in doing some quality work’, speaking of dedicated quality matrons working on the floor with nursing and care staff ‘demonstrating what good practice looks like’ and how mistakes are made and ‘how that translates to record-keeping, oversight and governance’. He said there is also a quality manager and the council has ‘dedicated a lot of clinical leadership resource’ to improve practice and said this has been particularly embedded at Millvina House ‘although we don’t know the outcome of the inspection yet.’
6.03pm - Cllr Williams is talking about union involvement and ‘freedom to speak up’ guardianship. She also asks whether there will be a clinical supervision set-up for staff. ‘Will the district nurses from Merseycare be spoken to to be part of that safety net?’. Lubanksi says she is ‘happy to encourage’ freedom to speak up. She said the main union involvement at Brushwood is GMB and ‘we speak to the trade unions fortnightly’. There are community matrons for supervision, she added, ‘and that is part of the offer for PC24’ and the council has brought in their own quality nurse because of the challenges.
6.03pm - Lubanksi is talking about succession planning for careers. ‘You can actually go as far as you want to go because there is a way of it happening’ she said.
6.02pm - Cllr Nicholas has asked: ‘has there been exploration with the colleges and universities to develop a programme that could help train?’ Lubanksi said the council was exploring a care academy.
6.02pm - ‘We’re working on a document that is about assurance’ Lubanski added, which will be brought back to committee.
6.01pm - She said things will still happen in the home but ‘what we’re doing now is the robustness of the check and challenge’.
6.01pm - ‘Has this plan been shared with CQC and how confident is CQC that the changes have been implemented as suggested’ and to ensure the errors ‘will not be repeated?’ Cllr Nicholas asked. Lubanksi said they have been shared and that ‘not all things will go smoothly’ as there will be human error.
5.59pm - Jordan Smith said there is a lot more time for the induction process to happen before new staff ‘hit the floor’ including shadow shifts and the feedback has been ‘really positive’ from the first cohort to benefit from the new training arrangements.
5.58pm - Cllr Nicholas is now asking about staff training and who was responsible for it before. Jordan Smith said there was a learning and development lead and then local managers were responsible for ensuring it happened. ‘That process wasn’t there locally within the service’ he adds.
5.58pm - Lubanksi is talking about issues around food, and said part of why it didn’t get addressed was it had not been seen as an issue.
5.57pm - ‘There’s a whole plan around culture and responsibility’ and part of that, Lubanksi adds, was to make people sign a document around that. She said she’s been emphasising with staff and families ‘it is positive not a negative to say something isn’t working’.
5.55pm - Cllr Nicholas, chair of the committee, asked why nobody whisteblew. ‘What was the culture in Brushwood that identified the inadequancy - did any of the staff whistleblow?’ Lubanksi said whistleblowing did not happen ‘in a meaningful way’. She spoke of ‘a bit of apathy’ and ‘fear’ amongst staff and families too.
5.54pm - Lubanksi has been talking about the task and finish group - which would be a working group for councillors on this scrutiny committee focused on the improvements - and she says a data dashboard can be brought to that meeting.
5.52pm - A lot of what’s in the report is safeguarding and learning. ‘We didn’t have a central process where we were documenting those things’ but do now.
5.52pm - Officer Smith said they’ve been doing a lot of work around KPIs (key performance indicators) and data dashboards.
5.50pm - Cllr Kimberley Berry is asking about a ‘deeper picture’ and ‘can you give us more indicators of how you measure the success or how things are going within Brushwood?’ she added, asking also about ‘key metrics and key indicators’ to be brought back to committee meetings.
5.49pm - ‘We’ve now got a really close connection between oversight of safeguarding outcomes, incident management reviews and workforce development and training’. He said ‘there will always be examples of poor care or safeguarding, I’m afraid this is inevitable’ officer Oxley added.
5.49pm - Officer Jason Oxley is talking about the wider social care market in Liverpool and work ongoing to improve outcomes. ‘We will be looking at all of our registered care homes and we will be taking the learning as well’ including learning from Brushwood into Millvina. The council has three other facilities that are registered as care homes ‘mainly for intermediate care - and we will look at all of those services’ Mr Oxley added.
5.48pm - Cllr Hasan asked about the other council-run homes and Cllr Coleman reiterated the improvement plan was across both homes.
5.47pm - Sometimes the fact of call bells going off (this was referenced in the inspection report) is around staff in the room not resetting it. ‘Now when the call bells go off its because somebody needs support’ rather than just background noise.
5.46pm - Call bells are being discussed now. ‘The call bells would go off but they were routed so they went off in the whole building’ which meant people wouldn’t pick up on it as it became ‘background noise’ so that has now been altered to only go off on a floor.
5.44pm - ‘The care plans are relating to the training of how to fill in the care plans’ officer Jordan Smith said. ‘Training is only part of it’ he added. ‘How does that training translate into practice?’ Some of this has been involving testing staff to create a ‘continuous learning culture’ of ‘what went wrong and how do we stop this happening again’ and getting rid of ‘fear’ in staff.
5.42pm - Cllr Coleman is talking now. She’s talking about contradictory care records mentioned and how ‘targeted work’ is being done to ‘improve people’s confidence’ around care plans.
5.42pm - ‘The system there is failing’ Cllr Hasan said, reading from the report. ‘LCC are guardians’ he added. He asked how the council can prevent the issues mentioned in the report from re-occuring?
5.42pm - Cllr Hasan asked about staff training. ‘Most of the training took place during the inspection time which is not satisfactory’
5.41pm - Cllr Coleman said that while the council has identified problems before the CQC inspection, some of this was around trying to find out ‘root cause’.
5.40pm - There were already fortnightly meetings with PC24 and the council before the CQC report was released, as well as other meetings between officers and managers at the home. ‘Because of other process, we have to make sure the homes are run safely and there is temporary management within the homes but also the director of nursing with PC24’ - it’s ‘really important’ that issues are discussed regularly. ‘We need to step back, reflect on where we are and where we want to get to in the coming months’.
5.38pm - ‘We are talking about five year contracts and we’re talking about holding ourselves rigorously accountable for the improvement journey’ and asked whether meetings should be more regular.
5.36pm - ‘The responsibility sits with the council’ she added, stating that it was the ‘right thing to do’ to renew PC24s contract. She said there are ‘five to six months to turn it around’. There have been improvements, she adds, ‘but I’m not undermining CQC’.
5.36pm - Lubanski said in terms of what CQC found, ‘in terms of some of the processes that were in the homes were not the right processes’. She said the council knew about some of the things in the CQC report. In terms of the market, it is ‘challenging’ and ‘it was a big decision for the council at the time’ to bring the homes in. In terms of working with PC24 we ‘did do our due diligence’. She said the CQC report describes it as if two organisations are working in the same home, but ‘we’ve been working hard with PC24 jointly to make that not be the case’.
5.33pm - The councillor said it was a ‘reasonable response’. ‘What I can’t get my head past is the thought…that everyone seems to agree that this service was requiring improvement’ and so asks about why the extension of PC24’s contract was decided, asking whether it was the market pressures.
5.32pm - Lubanski said that at the time the council was ‘optimistic’. ‘This is a different model in terms of what we’d been trying to achieve in terms of subcontracting.’
5.31pm - Cllr Sam East asked about the cabinet report from 24th February and ‘cautious optimism’ language used in the report. ‘Is it fair to say that optimism was misplaced?’
5.31pm - ‘We’re very clear with the staff’ she says, about ‘speaking up if they’re not happy’ with how things are being run.
5.30pm - ‘We’re going to create our own bank’ of staff Lubanski said. Referring to some of the challenges of working there, she added: ‘It’s a big home…a big building’. She said: ‘You will always have agency’ but the council have been ‘ensuring the staff are trained’.
5.29pm - Lubanksi said ‘I certainly don’t want agency’. Smith talks about the challenges of recruiting: There was a recent job for four carers and 98 applicants and that had been narrowed down to around 32. ‘It’s really difficult to recruit in social care’. An officer is talking about potential apprenticeships and how to raise the status of a care worker to attract people. Lubanksi says: ‘It’s a national issue.’.
5.27pm - Cllr Lucy Williams: ‘You’ve mentioned the improvement journey and how important it is for families to be involved.’ She added it is important for families too but speaks of the heavy reliance on agency staff. ‘A transient workforce…so how can staff become involved if the home is heavily reliant on agency staff?’
5.26pm - More generally ‘staff have been retrained’ and roles and responsibilities ‘are clear’. She added that staff have left and ‘that is what we’d expect in terms of holding people to account’.
5.25pm - Lubanksi is talking about strengthened staff training and inductions. ‘That is a journey’ and ‘we’ve gone backwards.’ She adds, ‘in terms of having met with lots of families…they want to be part of the improvement journey.’
5.24pm - The extension of PC24’s contract happened in February. Lubanksi is talking about regular - fortnightly - meetings with PC24. She also mentions the importance of listening to families. ‘We’ve tried to resolve things in time rather than waiting for it to happen.’
5.24pm - In terms of Cllr Brown’s question about hospital admissions Lubanksi said ‘I’m happy to look at that’.
5.23pm - In terms of safeguarding issues ‘I can’t answer the staff one’ Lubanksi says. ‘We notfiied CQC on a number of things, even historical things that should have been reported’.
5.23pm - ‘We’ve added to the improvement plan further to inspection’ Lubanksi adds.
5.22pm - The improvement plan - which was a joint plan for both homes - was initiated before the CQC inspection.
5.22pm - ‘The CQC arrived at Millvina two weeks ago’ Lubanski has told the committee.
5.21pm - He asks: ‘is the council now looking at Millvina House and what issues might be arising there’?
5.20pm - Cllr Kris Brown is speaking now about a previous meeting and is going through some of the issues in the report. ‘Have there been any issues relating to that…with service users requiring hospitalisation because of those issues?’ he asked. He said the report mentions a number of language issues, have those individual members…are they still on site and still dealing with service users at the home?’
5.19pm - Families are ‘scared about what happens next’ and need ‘openness and reassurance’. The family member spoke directly to Cllr Coleman to thank the council for communications ahead of the report being released. ‘Care at that home has been inadequate for far too long and that is not something that can carry on’ she concluded.
5.18pm - Speaking of when the council took over, she says: ‘It was inherited in a dreadful position, the care was actually dreadful’
5.18pm - She spoke of having moved her dad to the care home 12 months ago while mum was already there. ‘I do not regret that decision for one second…that CQC report does not reflect the level of care’ given to her parents.
5.17pm - ‘Staff actually care and you can’t train that’ the family member says, but ‘that is not reflected in the report’.
5.16pm - She spoke of staff ringing when parents might be unwell. ‘That says to me staff know my parents well enough to recognise subtle differences…they know my parents as people’ she adds.
5.15pm - ‘It was dangerous’ the family member said when the council first took over from previous provider and speaks of efforts by the council to ‘turn around substantial issues’. She said policies and practices ‘have been updated’, communications have improved. ‘It’s not unusual to get emails at least once or twice a day from Brushwood’ and says the service ‘truly knowns my parents’.
5.14pm - ‘A hard and shocking read’ is how the family member described the recent CQC report. She points out how Brushwood was already rated inadequate at the last inspection with three areas rates as requires improvement. Now it’s across all five domains. ‘That suggests the service has deterioriated’ but the family member said it ‘didn’t reflect’ her experiences. ‘Brushwood is not perfect’ but has been on an improvement journey.
5.13pm - Public speech from a family member of two residents. I’m probably quite unusual in that I have both parents in the care home’ but this means their experience ‘spans a substantial time’. She says she’s ‘not here to speak for all Brushwood families’.
5.13pm - Cabinet member Cllr Angela Coleman apologises to families.
5.12pm - Lubanksi talks about the importance of communication with resident families, and spoke of how for staff it was an ‘upsetting report’ and officers made sure to speak with them too on the date the report was released - which was September 9th.
5.11pm - The meeting aims to agree ‘next steps’ with the suggestion to ‘come back in a quarter and also to ask the chair to consider with the committee a task and finish group for members in order to work with us to oversee the improvement plan’ states Lubanksi.
5.10pm - ‘There are actions that are currently being taken that we can’t discuss in this meeting today as it wouldn’t be appropriate’ Lubanksi states. She says there is a ‘very strong relationship with PC24’ which provides nursing care and clinical oversight.
5.10pm - The officer is talking about meeting the Brushwood families. This update is being provided is by Anne Marie Lubanski, deputy chief executive and corporate director of adult social care and health.
5.07pm - An officer is addressing the committee, and offers an apology to residents and families. The actions in the report also relate to Millvina House.
5.07pm - We’re on to the main item on the agenda now. ‘Report sets out response to date’ as well as ‘increased oversight arrangement’ says chair Cllr Nicholas.
05.06pm - Declarations of interest now. Nobody is declaring an interest.
5.05pm - A family member and a communications officer for PC24, which provides the nursing care, are also here today for the meeting.
5.04pm - The councillors are now introducing themselves. There are a number of officers here today too.
5.02pm - The meeting has now begun with a bit of housekeeping.
4.58pm - Officers and councillors are assembling in the conference room on the sixth floor of the Cunard building as we wait for the meeting to begin. Internet’s a bit tetchy up here so apologies in advance if updates aren’t as speedy as they might otherwise be.
First time visiting the Mersey Monitor? Welcome! We’re an independent public interest news site covering Merseyside on a not-for-profit basis. Everything we publish is free to read, with no paywalls, and we’re funded by reader donations. You can sign up to receive our emails (they’re totally free) at the bottom of this page.
4.02pm - Welcome to today’s live updates. We’ll be following proceedings from the conference room at the Cunard building, where councillors on the adult social care and health scrutiny committee will be considering a report by the council into what has gone wrong at Brushwood and what is being done about it. We’ll be bringing you our coverage live from 5pm.
